Prime Geriatric Dental Care, PC

Primary specialty

DentistTaxonomy code 122300000X

License

D7017 Issued in OR

Legal business name

PRIME GERIATRIC DENTAL CARE, PC

Practice address

11400 SE 37TH Ave
Milwaukie, OR 97222-5982

Phone

(503) 774-6355

Fax

(503) 659-6325

NPI assigned

May 28, 2015

Last updated

May 28, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John T. Oki, DMD

Title

Secretary

Phone

(503) 774-6355

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brian D Koch, D.M.D.

  • General Practice Dentistry
  • Milwaukie, OR
  • NPI 1881641934
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432771200000",
    "number": "1437538972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 SE 37TH AVE",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972225982",
            "telephone_number": "503-774-6355",
            "fax_number": "503-659-6325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11400 SE 37TH AVE",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972225982",
            "telephone_number": "503-774-6355",
            "fax_number": "503-659-6325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME GERIATRIC DENTAL CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-28",
        "last_updated": "2015-05-28",
        "status": "A",
        "authorized_official_last_name": "OKI",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "503-774-6355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D7017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "071332",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Henry Prentice
• Justin David Preston, PT
• Eileena Gail Prettyman
• Raymond Price, LMT
• Prime Acupuncture and Herbology, LLC
• Prime Oquis Clinic, LLC
• Jennifer Primers, LMT
• Jessica M Prior, PHARMD
• Maria V Prokhorova, MD
• Protech Automotive Inc

• Dentist in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.